"Doctors work from facts."

A commenter that I’ve seen before on KevinMD left the following reply to someone today:

In response to [previous commenter], I have to say that “judgment free” can’t mean “evidence free”. Doctors work from facts. If you’re going to pay good money and risk your health, you, the patient, should demand that there be evidence supporting a treatment. If there’s no evidence, it’s generally better to do nothing and save your money.

So don’t demand your doctor be non-judgmental when we’re trained to judge based on evidence. That’s what you should want. Trust me, the people selling the line of BS you’re buying are judging based on their bottom line, whether they’re selling a nutritional supplement, a book, or merely their own ignorance.

See, here’s the problem with this comment. I don’t know how this theory plays out in cardiology or dermatology or oncology. I do know how this can play out in medical maternity care.

I have to say that “judgment free” can’t mean “evidence free”.

Yes.

Doctors work from facts.

Well, that wasn’t my experience. When I was passed around from practioner to practioner who sat there with their calendars open trying to schedule a c-section for suspected macrosomia (47 cm fundal height and late-term ultrasound saying 10 lbs., 2 oz.) in the absence of any risk factors, I asked them for their evidence. I had already dug through medical journals and found only Level C evidence and I let them know this in a very non-confrontational manner with some sincere pregnant lady tears and sniffles for good measure. The replies I got? Purely anecdotal. “I’ve seen shoulder dystocia and it’s really bad. You don’t want that.”

I don’t want that. You’re right. I also don’t want to get a piano dropped on my head from a third story apartment. Why are you not being honest about my odds? I just want facts, please. The clock is ticking and I’m not getting any less pregnant.

If you’re going to pay good money and risk your health, you, the patient, should demand that there be evidence supporting a treatment.

This was sort of irrelevant to the thread (about an Oprah episode with Jenny McCarthy as her guest), but this is exactly what we often hear about the practice of midwifery. You can have a bonus point if you’ve ever heard vaginal birth referred to as a “treatment.” Double if you regularly hear word of someone “performing a VBAC” and that someone to which they are referring is not the woman.

If there’s no evidence, it’s generally better to do nothing and save your money.

So if there’s no evidence that a cesarean is necessary, we can all sit back, wait for baby to arrive normally, catch baby and save money. Okay!

So don’t demand your doctor be non-judgmental when we’re trained to judge based on evidence. That’s what you should want.

I do! I do want that! Why didn’t I see that in medical maternity care? When can we see that in American hospitals?

Trust me, the people selling the line of BS you’re buying are judging based on their bottom line, whether they’re selling a nutritional supplement, a book, or merely their own ignorance.